|
AVAMAX BONE CEMENT DELIVERY SYS VMX00CT
|
Facility
OP
|
$2,721.00
|
|
| Hospital Charge Code |
4479294
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$925.14 |
| Max. Negotiated Rate |
$2,190.40 |
| Rate for Payer: Aetna of NY Commercial |
$1,904.70
|
| Rate for Payer: Aetna of NY Medicare |
$1,251.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,040.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,040.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,006.77
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,360.50
|
| Rate for Payer: Cash Price |
$2,040.75
|
| Rate for Payer: CDPHP Commercial |
$2,190.40
|
| Rate for Payer: CDPHP Medicare |
$1,006.77
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,176.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,176.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,176.80
|
| Rate for Payer: EmblemHealth Medicaid |
$2,176.80
|
| Rate for Payer: EmblemHealth Medicare |
$925.14
|
| Rate for Payer: EmblemHealth Select Care |
$1,959.12
|
| Rate for Payer: Fidelis Medicare |
$1,036.97
|
| Rate for Payer: Galaxy Health Commercial |
$1,768.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,006.77
|
| Rate for Payer: Humana Medicare |
$1,006.77
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,904.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,251.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,040.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,531.92
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,057.11
|
| Rate for Payer: United Healthcare Medicare |
$1,006.77
|
| Rate for Payer: WellCare Medicare |
$1,496.55
|
|
|
AVISTA MRI LEAD - 56CM/74CM
|
Facility
OP
|
$14,824.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
4479094
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,040.16 |
| Max. Negotiated Rate |
$11,933.32 |
| Rate for Payer: Aetna of NY Commercial |
$10,376.80
|
| Rate for Payer: Aetna of NY Medicare |
$6,819.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$6,670.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$6,670.80
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$5,484.88
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$7,412.00
|
| Rate for Payer: Cash Price |
$11,118.00
|
| Rate for Payer: CDPHP Commercial |
$11,933.32
|
| Rate for Payer: CDPHP Medicare |
$5,484.88
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7,412.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$11,859.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$11,859.20
|
| Rate for Payer: EmblemHealth Medicaid |
$11,859.20
|
| Rate for Payer: EmblemHealth Medicare |
$5,040.16
|
| Rate for Payer: EmblemHealth Select Care |
$7,412.00
|
| Rate for Payer: Fidelis Medicare |
$5,649.43
|
| Rate for Payer: Galaxy Health Commercial |
$9,635.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$5,484.88
|
| Rate for Payer: Humana Medicare |
$5,484.88
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10,376.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$6,819.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9,635.60
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9,635.60
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5,759.12
|
| Rate for Payer: United Healthcare Medicare |
$5,484.88
|
| Rate for Payer: WellCare Medicare |
$8,153.20
|
|
|
AVULSION OF NAIL PLATE,SIMPLE, SINGLE
|
Facility
OP
|
$573.00
|
|
|
Service Code
|
HCPCS 11730
|
| Hospital Charge Code |
4856671
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$190.75 |
| Max. Negotiated Rate |
$2,521.93 |
| Rate for Payer: Aetna of NY Commercial |
$401.10
|
| Rate for Payer: Aetna of NY Medicare |
$263.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2,017.33
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2,521.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$212.01
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$286.50
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: CDPHP Commercial |
$461.26
|
| Rate for Payer: CDPHP Medicare |
$212.01
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$458.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$458.40
|
| Rate for Payer: EmblemHealth Medicaid |
$458.40
|
| Rate for Payer: EmblemHealth Medicare |
$194.82
|
| Rate for Payer: Fidelis Medicare |
$218.37
|
| Rate for Payer: Galaxy Health Commercial |
$372.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$212.01
|
| Rate for Payer: Humana Medicare |
$212.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$401.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$263.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$429.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$322.60
|
| Rate for Payer: MVP Health Care of NY Medicare |
$222.61
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$190.75
|
| Rate for Payer: United Healthcare Medicare |
$212.01
|
| Rate for Payer: WellCare Medicare |
$315.15
|
|
|
AZACTAM 1 GRAM INJECTION
|
Facility
OP
|
$107.64
|
|
| Hospital Charge Code |
4409087
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.60 |
| Max. Negotiated Rate |
$86.65 |
| Rate for Payer: Aetna of NY Commercial |
$75.35
|
| Rate for Payer: Aetna of NY Medicare |
$49.51
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$80.73
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$80.73
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$39.83
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$53.82
|
| Rate for Payer: Cash Price |
$80.73
|
| Rate for Payer: CDPHP Commercial |
$86.65
|
| Rate for Payer: CDPHP Medicare |
$39.83
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$86.11
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$86.11
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$86.11
|
| Rate for Payer: EmblemHealth Medicaid |
$86.11
|
| Rate for Payer: EmblemHealth Medicare |
$36.60
|
| Rate for Payer: EmblemHealth Select Care |
$77.50
|
| Rate for Payer: Fidelis Medicare |
$41.02
|
| Rate for Payer: Galaxy Health Commercial |
$69.97
|
| Rate for Payer: Hamaspik Choice Medicare |
$39.83
|
| Rate for Payer: Humana Medicare |
$39.83
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$75.35
|
| Rate for Payer: Local 1199SEIU Medicare |
$49.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$80.73
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$60.60
|
| Rate for Payer: MVP Health Care of NY Medicare |
$41.82
|
| Rate for Payer: United Healthcare Medicare |
$39.83
|
| Rate for Payer: WellCare Medicare |
$59.20
|
|
|
AZACTAM (AZTREONAM) INJECTION 2 GRAMS
|
Facility
OP
|
$215.01
|
|
| Hospital Charge Code |
4409219
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$73.10 |
| Max. Negotiated Rate |
$173.08 |
| Rate for Payer: Aetna of NY Commercial |
$150.51
|
| Rate for Payer: Aetna of NY Medicare |
$98.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$161.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$161.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$79.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$107.50
|
| Rate for Payer: Cash Price |
$161.26
|
| Rate for Payer: CDPHP Commercial |
$173.08
|
| Rate for Payer: CDPHP Medicare |
$79.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$172.01
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$172.01
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$172.01
|
| Rate for Payer: EmblemHealth Medicaid |
$172.01
|
| Rate for Payer: EmblemHealth Medicare |
$73.10
|
| Rate for Payer: EmblemHealth Select Care |
$154.81
|
| Rate for Payer: Fidelis Medicare |
$81.94
|
| Rate for Payer: Galaxy Health Commercial |
$139.76
|
| Rate for Payer: Hamaspik Choice Medicare |
$79.55
|
| Rate for Payer: Humana Medicare |
$79.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$150.51
|
| Rate for Payer: Local 1199SEIU Medicare |
$98.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$161.26
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$121.05
|
| Rate for Payer: MVP Health Care of NY Medicare |
$83.53
|
| Rate for Payer: United Healthcare Medicare |
$79.55
|
| Rate for Payer: WellCare Medicare |
$118.26
|
|
|
AZITHROMYCIN 100MG/5ML POSR 15 ML
|
Facility
OP
|
$104.64
|
|
| Hospital Charge Code |
4400087
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.58 |
| Max. Negotiated Rate |
$84.24 |
| Rate for Payer: Aetna of NY Commercial |
$73.25
|
| Rate for Payer: Aetna of NY Medicare |
$48.13
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$78.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$78.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$38.72
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$52.32
|
| Rate for Payer: Cash Price |
$78.48
|
| Rate for Payer: CDPHP Commercial |
$84.24
|
| Rate for Payer: CDPHP Medicare |
$38.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$83.71
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$83.71
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$83.71
|
| Rate for Payer: EmblemHealth Medicaid |
$83.71
|
| Rate for Payer: EmblemHealth Medicare |
$35.58
|
| Rate for Payer: EmblemHealth Select Care |
$75.34
|
| Rate for Payer: Fidelis Medicare |
$39.88
|
| Rate for Payer: Galaxy Health Commercial |
$68.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$38.72
|
| Rate for Payer: Humana Medicare |
$38.72
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$73.25
|
| Rate for Payer: Local 1199SEIU Medicare |
$48.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$78.48
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$58.91
|
| Rate for Payer: MVP Health Care of NY Medicare |
$40.65
|
| Rate for Payer: United Healthcare Medicare |
$38.72
|
| Rate for Payer: WellCare Medicare |
$57.55
|
|
|
AZITHROMYCIN 250MG TABS
|
Facility
OP
|
$16.50
|
|
| Hospital Charge Code |
4400088
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$13.28 |
| Rate for Payer: Aetna of NY Commercial |
$11.55
|
| Rate for Payer: Aetna of NY Medicare |
$7.59
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$12.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$12.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6.10
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$8.25
|
| Rate for Payer: Cash Price |
$12.38
|
| Rate for Payer: CDPHP Commercial |
$13.28
|
| Rate for Payer: CDPHP Medicare |
$6.10
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$13.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$13.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$13.20
|
| Rate for Payer: EmblemHealth Medicaid |
$13.20
|
| Rate for Payer: EmblemHealth Medicare |
$5.61
|
| Rate for Payer: EmblemHealth Select Care |
$11.88
|
| Rate for Payer: Fidelis Medicare |
$6.29
|
| Rate for Payer: Galaxy Health Commercial |
$10.72
|
| Rate for Payer: Hamaspik Choice Medicare |
$6.10
|
| Rate for Payer: Humana Medicare |
$6.10
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$11.55
|
| Rate for Payer: Local 1199SEIU Medicare |
$7.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.38
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9.29
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.41
|
| Rate for Payer: United Healthcare Medicare |
$6.10
|
| Rate for Payer: WellCare Medicare |
$9.08
|
|
|
AZITHROMYCIN 500 MG INJ
|
Facility
OP
|
$22.15
|
|
|
Service Code
|
HCPCS J0456
|
| Hospital Charge Code |
4400089
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.41 |
| Max. Negotiated Rate |
$17.83 |
| Rate for Payer: Aetna of NY Commercial |
$12.18
|
| Rate for Payer: Aetna of NY Medicare |
$10.19
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$2.41
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$2.41
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.20
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$11.08
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: CDPHP Commercial |
$17.83
|
| Rate for Payer: CDPHP Medicare |
$8.20
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2.41
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$17.72
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$17.72
|
| Rate for Payer: EmblemHealth Medicaid |
$17.72
|
| Rate for Payer: EmblemHealth Medicare |
$7.53
|
| Rate for Payer: EmblemHealth Select Care |
$2.41
|
| Rate for Payer: Fidelis Medicare |
$8.44
|
| Rate for Payer: Galaxy Health Commercial |
$14.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.20
|
| Rate for Payer: Humana Medicare |
$8.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$12.18
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$16.61
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.47
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.61
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$4.59
|
| Rate for Payer: United Healthcare Commercial |
$4.59
|
| Rate for Payer: United Healthcare Medicare |
$8.20
|
| Rate for Payer: WellCare Medicare |
$12.18
|
|
|
BACITRACIN 50000 U
|
Facility
OP
|
$41.20
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
4400092
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.01 |
| Max. Negotiated Rate |
$33.17 |
| Rate for Payer: Aetna of NY Commercial |
$22.66
|
| Rate for Payer: Aetna of NY Medicare |
$18.95
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$18.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$18.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$15.24
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$20.60
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: CDPHP Commercial |
$33.17
|
| Rate for Payer: CDPHP Medicare |
$15.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$32.96
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$32.96
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$32.96
|
| Rate for Payer: EmblemHealth Medicaid |
$32.96
|
| Rate for Payer: EmblemHealth Medicare |
$14.01
|
| Rate for Payer: EmblemHealth Select Care |
$29.66
|
| Rate for Payer: Fidelis Medicare |
$15.70
|
| Rate for Payer: Galaxy Health Commercial |
$26.78
|
| Rate for Payer: Hamaspik Choice Medicare |
$15.24
|
| Rate for Payer: Humana Medicare |
$15.24
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$22.66
|
| Rate for Payer: Local 1199SEIU Medicare |
$18.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.90
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$23.20
|
| Rate for Payer: MVP Health Care of NY Medicare |
$16.01
|
| Rate for Payer: United Healthcare Medicare |
$15.24
|
| Rate for Payer: WellCare Medicare |
$22.66
|
|
|
BACITRACIN/POLYMYXIN B 500-10000U/GM OIN
|
Facility
OP
|
$79.31
|
|
| Hospital Charge Code |
4400025
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.97 |
| Max. Negotiated Rate |
$63.84 |
| Rate for Payer: Aetna of NY Commercial |
$55.52
|
| Rate for Payer: Aetna of NY Medicare |
$36.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$59.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$59.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$29.34
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$39.66
|
| Rate for Payer: Cash Price |
$59.48
|
| Rate for Payer: CDPHP Commercial |
$63.84
|
| Rate for Payer: CDPHP Medicare |
$29.34
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$63.45
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$63.45
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$63.45
|
| Rate for Payer: EmblemHealth Medicaid |
$63.45
|
| Rate for Payer: EmblemHealth Medicare |
$26.97
|
| Rate for Payer: EmblemHealth Select Care |
$57.10
|
| Rate for Payer: Fidelis Medicare |
$30.23
|
| Rate for Payer: Galaxy Health Commercial |
$51.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$29.34
|
| Rate for Payer: Humana Medicare |
$29.34
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$55.52
|
| Rate for Payer: Local 1199SEIU Medicare |
$36.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$59.48
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$44.65
|
| Rate for Payer: MVP Health Care of NY Medicare |
$30.81
|
| Rate for Payer: United Healthcare Medicare |
$29.34
|
| Rate for Payer: WellCare Medicare |
$43.62
|
|
|
BACLOFEN 20MG TABS 10X10EA
|
Facility
OP
|
$6.18
|
|
| Hospital Charge Code |
4400095
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
BACLOFEN 5 MG TABLET 5 mg, 100 eaches
|
Facility
OP
|
$6.00
|
|
| Hospital Charge Code |
4401493
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Aetna of NY Commercial |
$4.20
|
| Rate for Payer: Aetna of NY Medicare |
$2.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.22
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.00
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: CDPHP Commercial |
$4.83
|
| Rate for Payer: CDPHP Medicare |
$2.22
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.80
|
| Rate for Payer: EmblemHealth Medicaid |
$4.80
|
| Rate for Payer: EmblemHealth Medicare |
$2.04
|
| Rate for Payer: EmblemHealth Select Care |
$4.32
|
| Rate for Payer: Fidelis Medicare |
$2.29
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.22
|
| Rate for Payer: Humana Medicare |
$2.22
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.33
|
| Rate for Payer: United Healthcare Medicare |
$2.22
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
BACTERIAL CULTURE
|
Facility
OP
|
$34.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
4300109
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$27.37 |
| Rate for Payer: Aetna of NY Commercial |
$22.10
|
| Rate for Payer: Aetna of NY Medicare |
$15.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$25.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$25.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.58
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$17.00
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: CDPHP Commercial |
$27.37
|
| Rate for Payer: CDPHP Medicare |
$12.58
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$27.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$27.20
|
| Rate for Payer: EmblemHealth Medicaid |
$27.20
|
| Rate for Payer: EmblemHealth Medicare |
$11.56
|
| Rate for Payer: Fidelis Medicare |
$12.96
|
| Rate for Payer: Galaxy Health Commercial |
$22.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.58
|
| Rate for Payer: Humana Medicare |
$12.58
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$22.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$25.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$19.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.21
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$25.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.23
|
| Rate for Payer: United Healthcare Commercial |
$25.50
|
| Rate for Payer: United Healthcare Medicare |
$12.58
|
| Rate for Payer: WellCare Medicare |
$18.70
|
|
|
BACTERIAL ID
|
Facility
OP
|
$32.00
|
|
|
Service Code
|
HCPCS 87077
|
| Hospital Charge Code |
4301088
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$25.76 |
| Rate for Payer: Aetna of NY Commercial |
$20.80
|
| Rate for Payer: Aetna of NY Medicare |
$14.72
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$24.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$24.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$11.84
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$16.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: CDPHP Commercial |
$25.76
|
| Rate for Payer: CDPHP Medicare |
$11.84
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$25.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$25.60
|
| Rate for Payer: EmblemHealth Medicaid |
$25.60
|
| Rate for Payer: EmblemHealth Medicare |
$10.88
|
| Rate for Payer: Fidelis Medicare |
$12.20
|
| Rate for Payer: Galaxy Health Commercial |
$20.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$11.84
|
| Rate for Payer: Humana Medicare |
$11.84
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$20.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$14.72
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$18.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.43
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$24.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.08
|
| Rate for Payer: United Healthcare Commercial |
$24.00
|
| Rate for Payer: United Healthcare Medicare |
$11.84
|
| Rate for Payer: WellCare Medicare |
$17.60
|
|
|
BALANCE B-50 TABLET 1 ea, 1 each
|
Facility
OP
|
$6.00
|
|
| Hospital Charge Code |
4401327
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Aetna of NY Commercial |
$4.20
|
| Rate for Payer: Aetna of NY Medicare |
$2.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.22
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.00
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: CDPHP Commercial |
$4.83
|
| Rate for Payer: CDPHP Medicare |
$2.22
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.80
|
| Rate for Payer: EmblemHealth Medicaid |
$4.80
|
| Rate for Payer: EmblemHealth Medicare |
$2.04
|
| Rate for Payer: EmblemHealth Select Care |
$4.32
|
| Rate for Payer: Fidelis Medicare |
$2.29
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.22
|
| Rate for Payer: Humana Medicare |
$2.22
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.33
|
| Rate for Payer: United Healthcare Medicare |
$2.22
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
BARRIER SKIN 1 1/2 FLEX COST BOX
|
Facility
OP
|
$22.00
|
|
| Hospital Charge Code |
4479129
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$17.71 |
| Rate for Payer: Aetna of NY Commercial |
$15.40
|
| Rate for Payer: Aetna of NY Medicare |
$10.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$16.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$16.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.14
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$11.00
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: CDPHP Commercial |
$17.71
|
| Rate for Payer: CDPHP Medicare |
$8.14
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$17.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$17.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$17.60
|
| Rate for Payer: EmblemHealth Medicaid |
$17.60
|
| Rate for Payer: EmblemHealth Medicare |
$7.48
|
| Rate for Payer: EmblemHealth Select Care |
$15.84
|
| Rate for Payer: Fidelis Medicare |
$8.38
|
| Rate for Payer: Galaxy Health Commercial |
$14.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.14
|
| Rate for Payer: Humana Medicare |
$8.14
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$15.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$16.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.39
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.55
|
| Rate for Payer: United Healthcare Medicare |
$8.14
|
| Rate for Payer: WellCare Medicare |
$12.10
|
|
|
BARRIER SKIN 11/4 FLEX
|
Facility
OP
|
$22.00
|
|
| Hospital Charge Code |
4479128
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$17.71 |
| Rate for Payer: Aetna of NY Commercial |
$15.40
|
| Rate for Payer: Aetna of NY Medicare |
$10.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$16.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$16.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.14
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$11.00
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: CDPHP Commercial |
$17.71
|
| Rate for Payer: CDPHP Medicare |
$8.14
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$17.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$17.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$17.60
|
| Rate for Payer: EmblemHealth Medicaid |
$17.60
|
| Rate for Payer: EmblemHealth Medicare |
$7.48
|
| Rate for Payer: EmblemHealth Select Care |
$15.84
|
| Rate for Payer: Fidelis Medicare |
$8.38
|
| Rate for Payer: Galaxy Health Commercial |
$14.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.14
|
| Rate for Payer: Humana Medicare |
$8.14
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$15.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$16.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.39
|
| Rate for Payer: MVP Health Care of NY Medicare |
$8.55
|
| Rate for Payer: United Healthcare Medicare |
$8.14
|
| Rate for Payer: WellCare Medicare |
$12.10
|
|
|
BARRIER SKIN 2 1/4 FLEX COST BOX
|
Facility
OP
|
$27.00
|
|
| Hospital Charge Code |
4479130
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$21.74 |
| Rate for Payer: Aetna of NY Commercial |
$18.90
|
| Rate for Payer: Aetna of NY Medicare |
$12.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$20.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$20.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.99
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$13.50
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: CDPHP Commercial |
$21.74
|
| Rate for Payer: CDPHP Medicare |
$9.99
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$21.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$21.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$21.60
|
| Rate for Payer: EmblemHealth Medicaid |
$21.60
|
| Rate for Payer: EmblemHealth Medicare |
$9.18
|
| Rate for Payer: EmblemHealth Select Care |
$19.44
|
| Rate for Payer: Fidelis Medicare |
$10.29
|
| Rate for Payer: Galaxy Health Commercial |
$17.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.99
|
| Rate for Payer: Humana Medicare |
$9.99
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$18.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$12.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$15.20
|
| Rate for Payer: MVP Health Care of NY Medicare |
$10.49
|
| Rate for Payer: United Healthcare Medicare |
$9.99
|
| Rate for Payer: WellCare Medicare |
$14.85
|
|
|
BARRIER SKIN 2 3/4 FLEX COST BOX 10
|
Facility
OP
|
$27.00
|
|
| Hospital Charge Code |
4479131
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$21.74 |
| Rate for Payer: Aetna of NY Commercial |
$18.90
|
| Rate for Payer: Aetna of NY Medicare |
$12.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$20.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$20.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.99
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$13.50
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: CDPHP Commercial |
$21.74
|
| Rate for Payer: CDPHP Medicare |
$9.99
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$21.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$21.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$21.60
|
| Rate for Payer: EmblemHealth Medicaid |
$21.60
|
| Rate for Payer: EmblemHealth Medicare |
$9.18
|
| Rate for Payer: EmblemHealth Select Care |
$19.44
|
| Rate for Payer: Fidelis Medicare |
$10.29
|
| Rate for Payer: Galaxy Health Commercial |
$17.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.99
|
| Rate for Payer: Humana Medicare |
$9.99
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$18.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$12.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$15.20
|
| Rate for Payer: MVP Health Care of NY Medicare |
$10.49
|
| Rate for Payer: United Healthcare Medicare |
$9.99
|
| Rate for Payer: WellCare Medicare |
$14.85
|
|
|
BASIC DIAGNOSTIC TRAY (BREAST BIOPSY)
|
Facility
OP
|
$37.00
|
|
| Hospital Charge Code |
4473020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.58 |
| Max. Negotiated Rate |
$29.78 |
| Rate for Payer: Aetna of NY Commercial |
$25.90
|
| Rate for Payer: Aetna of NY Medicare |
$17.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$27.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$27.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$13.69
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$18.50
|
| Rate for Payer: Cash Price |
$27.75
|
| Rate for Payer: CDPHP Commercial |
$29.78
|
| Rate for Payer: CDPHP Medicare |
$13.69
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$29.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$29.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$29.60
|
| Rate for Payer: EmblemHealth Medicaid |
$29.60
|
| Rate for Payer: EmblemHealth Medicare |
$12.58
|
| Rate for Payer: EmblemHealth Select Care |
$26.64
|
| Rate for Payer: Fidelis Medicare |
$14.10
|
| Rate for Payer: Galaxy Health Commercial |
$24.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$13.69
|
| Rate for Payer: Humana Medicare |
$13.69
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$25.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$20.83
|
| Rate for Payer: MVP Health Care of NY Medicare |
$14.37
|
| Rate for Payer: United Healthcare Medicare |
$13.69
|
| Rate for Payer: WellCare Medicare |
$20.35
|
|
|
BASIC METABOLIC PANEL
|
Facility
OP
|
$48.00
|
|
|
Service Code
|
HCPCS 80048
|
| Hospital Charge Code |
4300117
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.32 |
| Max. Negotiated Rate |
$38.64 |
| Rate for Payer: Aetna of NY Commercial |
$31.20
|
| Rate for Payer: Aetna of NY Medicare |
$22.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$36.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$36.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$17.76
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$24.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: CDPHP Commercial |
$38.64
|
| Rate for Payer: CDPHP Medicare |
$17.76
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$38.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$38.40
|
| Rate for Payer: EmblemHealth Medicaid |
$38.40
|
| Rate for Payer: EmblemHealth Medicare |
$16.32
|
| Rate for Payer: Fidelis Medicare |
$18.29
|
| Rate for Payer: Galaxy Health Commercial |
$31.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$17.76
|
| Rate for Payer: Humana Medicare |
$17.76
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$31.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$22.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$36.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$27.02
|
| Rate for Payer: MVP Health Care of NY Medicare |
$18.65
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$36.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.32
|
| Rate for Payer: United Healthcare Commercial |
$36.00
|
| Rate for Payer: United Healthcare Medicare |
$17.76
|
| Rate for Payer: WellCare Medicare |
$26.40
|
|
|
BASIC PACKS
|
Facility
OP
|
$40.00
|
|
| Hospital Charge Code |
4479173
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$32.20 |
| Rate for Payer: Aetna of NY Commercial |
$28.00
|
| Rate for Payer: Aetna of NY Medicare |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$30.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$30.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$14.80
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$20.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: CDPHP Commercial |
$32.20
|
| Rate for Payer: CDPHP Medicare |
$14.80
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$32.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$32.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$32.00
|
| Rate for Payer: EmblemHealth Medicaid |
$32.00
|
| Rate for Payer: EmblemHealth Medicare |
$13.60
|
| Rate for Payer: EmblemHealth Select Care |
$28.80
|
| Rate for Payer: Fidelis Medicare |
$15.24
|
| Rate for Payer: Galaxy Health Commercial |
$26.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$14.80
|
| Rate for Payer: Humana Medicare |
$14.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$28.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$18.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$22.52
|
| Rate for Payer: MVP Health Care of NY Medicare |
$15.54
|
| Rate for Payer: United Healthcare Medicare |
$14.80
|
| Rate for Payer: WellCare Medicare |
$22.00
|
|
|
BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT
|
Facility
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 96127
|
| Hospital Charge Code |
4600003
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$38.21 |
| Max. Negotiated Rate |
$92.58 |
| Rate for Payer: Aetna of NY Commercial |
$80.50
|
| Rate for Payer: Aetna of NY Medicare |
$52.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$86.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$86.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$42.55
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$57.50
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: Cash Price |
$86.25
|
| Rate for Payer: CDPHP Commercial |
$92.58
|
| Rate for Payer: CDPHP Medicare |
$42.55
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$92.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$92.00
|
| Rate for Payer: EmblemHealth Medicaid |
$92.00
|
| Rate for Payer: EmblemHealth Medicare |
$39.10
|
| Rate for Payer: Fidelis Medicare |
$43.83
|
| Rate for Payer: Galaxy Health Commercial |
$74.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$42.55
|
| Rate for Payer: Humana Medicare |
$42.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$80.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$52.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$86.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$64.74
|
| Rate for Payer: MVP Health Care of NY Medicare |
$44.68
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$38.21
|
| Rate for Payer: United Healthcare Medicare |
$42.55
|
| Rate for Payer: WellCare Medicare |
$63.25
|
|
|
BEHAVRAL QUALIT ANALYS VOICE
|
Facility
OP
|
$394.00
|
|
|
Service Code
|
HCPCS 92524 GN
|
| Hospital Charge Code |
4670254
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$317.17 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$181.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$295.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$295.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$145.78
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: CDPHP Commercial |
$317.17
|
| Rate for Payer: CDPHP Medicare |
$145.78
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$315.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$315.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$315.20
|
| Rate for Payer: EmblemHealth Medicaid |
$315.20
|
| Rate for Payer: EmblemHealth Medicare |
$133.96
|
| Rate for Payer: EmblemHealth Select Care |
$283.68
|
| Rate for Payer: Fidelis Medicare |
$150.15
|
| Rate for Payer: Galaxy Health Commercial |
$256.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$145.78
|
| Rate for Payer: Humana Medicare |
$145.78
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$181.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$153.07
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$145.78
|
| Rate for Payer: WellCare Medicare |
$216.70
|
|
|
BEHAVRAL QUALIT ANALYS VOICE (MOD 59)
|
Facility
OP
|
$394.00
|
|
|
Service Code
|
HCPCS 92524 GN,59
|
| Hospital Charge Code |
4670294
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$317.17 |
| Rate for Payer: Aetna of NY Commercial |
$112.00
|
| Rate for Payer: Aetna of NY Medicare |
$181.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$295.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$295.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$145.78
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$108.00
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: CDPHP Commercial |
$317.17
|
| Rate for Payer: CDPHP Medicare |
$145.78
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$315.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$315.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$315.20
|
| Rate for Payer: EmblemHealth Medicaid |
$315.20
|
| Rate for Payer: EmblemHealth Medicare |
$133.96
|
| Rate for Payer: EmblemHealth Select Care |
$283.68
|
| Rate for Payer: Fidelis Medicare |
$150.15
|
| Rate for Payer: Galaxy Health Commercial |
$256.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$145.78
|
| Rate for Payer: Humana Medicare |
$145.78
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$112.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$181.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$179.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$134.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$153.07
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$156.00
|
| Rate for Payer: United Healthcare Medicare |
$145.78
|
| Rate for Payer: WellCare Medicare |
$216.70
|
|
